tbuckley/cabot-search huggingface dataset:
Abstract 11864: Incidence and Predictors of Left Atrial Thrombus in Patients With Atrial Fibrillation Under Standard Anticoagulation Therapy
Authors: Joong Min Lee, Min Soo Cho, Myung-jin Cha, Jun Kim, Nam Gi-Byoung, Kee-joon Choi
Journal: Circulation (2022)

Background: The left atrial thrombus (LAT) formation is associated with thromboembolic events in atrial fibrillation (AF) patients. Objective: We investigated the incidence and associated factors of LAT in patients with AF who already on standard anticoagulation therapy. Methods: Medical records of 1,122 AF patients (mean 59.4 ± 11.0 years old, 58.3% male) who were on standard anticoagulation and underwent transesophageal echocardiography (TEE) from 2009 to 2019 were evaluated. Baseline clinical and echocardiographic data were analyzed. The main outcome of the study was the presence of LAT on TEE. The associated factors of the LAT were analyzed. Results: Warfarin and non-vitamin K oral anticoagulants (NOAC) were used in 74.4% and 25.6% of the patients. Among these patients, LAT was found in 60 patients (5.3%). The significant predictors of the LAT on TEE were elders (&gt;75 years old, Odd ratio [OR] 1.99 [95% confidence interval 0.88-4.24]), persistent/permanent AF (OR 2.63 [1.45-4.95]), high CHA2DS2-VASc score (≥3 points, OR 2.06 [1.15-3.74]), low left ventricular ejection fraction (&lt;40%, OR 2.12 [0.97-4.33]), and moderate-severe left atrial enlargement (LAE) (OR 3.92 [1.95-8.59]). Moderate-severe mitral regurgitation (MR) was associated with lower odds for LAT (OR 0.146 [0.04-0.37]). We gave each variable a score according to its weight (-3 points for MR, 2 points for LAE, and 1 point for the rest). If our risk score is 3 or more, the rate of LAT increases to 8.7% or more. Conclusions: Several clinical and echocardiographic predictors were useful for predicting presence of LAT in AF patients who are already on anticoagulation treatment. Screening for LA thrombus before left atrial interventions such as cardioversion, ablation procedure, or appendage occluder, should be warranted in patients with high risk score.
Abstract 10261: Adverse Childhood Experiences Are Linked to High Blood Pressure During the First Trimester and Hypertensive Complications During Pregnancy
Authors: Nathaniel J Helwig, Karina Shreffler, Laura Schwager, Emily Thomas, Nathaniel Jenkins
Journal: Circulation (2022)

Introduction: Adverse Childhood Experiences (ACEs) are associated with impaired vascular function in young adult women, and increased blood pressure and CVD risk later in life. Hypotheses: We hypothesized that exposure to ACEs would be associated with an increased risk of first trimester hypertension and subsequently with hypertensive complications during pregnancy. Methods: Exposure to ACEs, self-reported incidence of first trimester hypertension (HT) and hypertensive complications in pregnancy (HTCs), as well as age, education, chronic health conditions, gravidity and BMI were obtained from women enrolled in a clinic-based longitudinal study of women ages 16-38 who were enrolled in their first prenatal visit. To avoid potential confounding of severe obesity, we restricted analyses to only those women with a BMI &lt;40 kg/m 2 . Consequently, 135 pregnant women (age = 26 ± 6; BMI = 27 ± 6; gravidity = 2.7 ± 1.5) were included in this analysis; however, data from 20 women was missing for HTC incidence (n =115). The sample was diverse (49% Non-White) and had a high prevalence of ACEs (41% with ≥4 ACEs). Logistic regression models were used to examine the association of ACE exposure with the probability of HT and HTCs. Models included: (1) ACEs alone, and (2) ACEs following adjustment for age, BMI, gravidity, Race, and chronic health conditions. Results: Exposure to ACEs predicted HT (OR [95% CI] = 1.32 [1.10 - 1.59]) and HTC (1.26 [1.03 - 1.52]) incidence. Following full adjustment, the odds of HT increased 51% for each additional ACE (1.51 [1.03 - 2.22]). Following full adjustment, the odds of HTC increased 40% for each additional ACE (1.40 [1.06 - 1.83]). In each of the fully adjusted models, only chronic health conditions were also a significant predictor. Conclusions: ACE exposure is an important risk factor for HT and HTC, especially when considered alongside existing chronic health conditions. Screening for ACEs may be a worthwhile public health strategy to identify women at risk for hypertension and hypertensive complications in pregnancy. However, larger scale, longitudinal cohort studies are needed to confirm and to further understand these associations.
Abstract 10318: Polyunsaturated Fatty Acids, EPA and DHA Possess a Potent P300-hat Inhibitor and Prevent Mi-Induced Development of Heart Failure in Rats
Authors: Yoichi Sunagawa, Masafumi Funamoto, Toshihide Hamabe-Horiike, Kana Shimizu, Satoshi Shimizu, Yasufumi Katanasaka, Ryota Hosomi, Koji Hasegawa, Tatsuya Morimoto
Journal: Circulation (2022)

Introduction: The histone acetyltransferase (HAT) activity of p300 has a crucial role in the development of heart failure. Although many studies have shown a cardioprotective effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), omega-3 unsaturated fatty acids, little is known about the effects of these acids on cardiomyocyte hypertrophy. In this study, we investigated the effects of these acids on cardiomyocyte hypertrophy and the development of heart failure in rats with myocardial infarction (MI). Methods and Results: In cardiomyocytes, EPA and DHA (10 μM) significantly suppressed equally PE-induced cardiomyocyte hypertrophy, hypertrophy-response gene transcriptions, and acetylation of histone-H3K9. Furthermore, p300-induced hypertrophic responses were also suppressed by EPA and DHA. The result of an in vitro p300-HAT assay revealed that EPA and DHA directly inhibited p300-HAT activity (IC50: 37.8 μM, 30.6 μM) and induced allosteric inhibition of histones and competitive inhibition of acetyl-CoA in vitro . In addition, palmitic acid and stearic acid could not inhibit them. MI-operated rats (FS&lt;40%) were randomly assigned to 3 groups; vehicle (saline), EPA, and DHA (1g/kg). One week after the operation, oral administrations were repeated for 6 weeks. The echocardiographic analysis demonstrated that both EPA and DHA treatments prevented MI-induced left ventricular remodeling with preserved FS. Furthermore, EPA and DHA significantly suppressed the MI-induced increase in myocardial cell diameter, perivascular fibrosis, mRNA levels of hypertrophic and fibrotic markers, and acetylation of histone H3K9. In the left ventricle, EPA contents were lower than those of the other fatty acids, and no difference in each group. The EPA group exhibited higher docosapentaenoic acid (DPA) and DHA content than the vehicle group. The DHA group increased DHA content but not DPA and EPA contents. Conclusion: These results suggested that both EPA and DHA suppressed MI-induced development of heart failure through the inhibition of p300-HAT activity. The cardioprotective effect of EPA on MI might be attributed to the conversion of DHA or EPA metabolites.
Abstract 10933: Artificial Intelligence Enabled Fully Automated Myocardial Strain Quantification for Risk Stratification Following Acute Myocardial Infarction
Authors: Soeren J Backhaus, Haneen Aldehayat, Johannes Kowallick, Ruben Evertz, Torben Lange, Shelby Kutty, Boris Bigalke, Gerd Hasenfuss, Holger Thiele, Thomas Stiermaier, Ingo Eitel, Andreas Schuster
Journal: Circulation (2022)

Introduction: Feasibility of automated volume-derived cardiac functional evaluation has successfully been demonstrated using cardiovascular magnetic resonance (CMR) imaging. Notwithstanding, strain assessment has proven incremental value for cardiovascular risk stratification. Since introduction of deformation imaging to clinical practice has been complicated by time-consuming post-processing, we sought to investigate automation respectively. Methods: CMR data (n=1095 patients) from two prospectively recruited acute myocardial infarction (AMI) populations with ST-elevation (STEMI) (AIDA STEMI n=759) and non-STEMI (TATORT-NSTEMI n=336) were analysed fully automated and manually on conventional cine sequences. LV function assessment included global longitudinal, circumferential, and radial strains (GLS/GCS/GRS). Agreements were assessed between automated and manual strain assessments. The former were assessed for major adverse cardiac event (MACE) prediction within 12 months following AMI. Results: Manual and automated derived GLS showed the best and excellent agreement with an intraclass correlation coefficient (ICC) of 0.81. Agreement was good for GCS and poor for GRS. Amongst automated analyses, GLS (HR 1.12, 95% CI 1.08-1.16, p&lt;0.001) and GCS (HR 1.07, 95% CI 1.05-1.10, p&lt;0.001) best predicted MACE with similar diagnostic accuracy compared to manual analyses; area under the curve (AUC) for GLS (auto 0.691 vs. manual 0.693, p=0.801) and GCS (auto 0.668 vs. manual 0.686, p=0.425). Amongst automated functional analyses, GLS was the only independent predictor of MACE in multivariate analyses (HR 1.10, 95% CI 1.04-1.15, p&lt;0.001). Conclusions: Considering high agreement of automated GLS and equally high accuracy for risk prediction compared to the reference standard of manual analyses, automation may improve efficiency and aid in clinical routine CMR examinations.
Abstract 10191: Associations of Urine Biomarkers of Kidney Tubule Health With Incident Hypertension and Blood Pressure Trajectories in Middle-Aged Adults
Authors: Bilal Khan, Rebecca Scherzer, Cora E Lewis, Michael Shlipak, Joachim H IX, Orlando M GUTIERREZ
Journal: Circulation (2022)

Introduction: Kidney tubules play a key role in regulating blood pressure (BP). Urine biomarkers of kidney tubule injury associate with incident hypertension (HTN) in older adults with multiple comorbidities. Less is known about these associations in younger adults. Hypothesis: Urine biomarkers of kidney tubular injury and dysfunction associate with incident HTN and greater 10-year rise in BP in middle-aged adults. Methods: In 1,170 participants of the Coronary Artery Risk Development in Young Adults (CARDIA) study (mean age 45±4, 40% black, 56% women) without HTN, cardiovascular disease or kidney disease at the year 20 exam (baseline for this analysis), we measured urine monocyte chemoattractant protein-1, alpha-1-microglobulin, kidney injury molecule-1, epidermal growth factor [EGF], interleukin-18, chitinase-3-like protein 1, and uromodulin. We examined associations of biomarkers with incident HTN (onset of systolic BP ≥130 mmHg or diastolic BP ≥80 mmHg or initiation of BP meds) after baseline in interval-censored Cox models and BP trajectories in linear mixed models adjusted for established risk factors. Results: During a median 9.9 years of follow up (IQR 5.9-10.2), 376 incident HTN events occurred. Compared to the lowest tertile of EGF, the risk of incident HTN was lower in the two higher tertiles in the model adjusted for age, sex, race, and urine creatinine, and in the fully adjusted model (Figure). The mean increase in SBP over 10 years was 3.4 mmHg lower in Tertile 3 vs. Tertile 1 of EGF (95%CI -6.1, -0.7). There were no statistically significant associations of urine EGF with incident HTN or BP trajectories when EGF was modeled as a continuous predictor. There were no statistically significant associations of other biomarkers with incident HTN or BP trajectory. Conclusions: In middle aged adults without HTN, cardiovascular or kidney disease, higher urine EGF levels associated with lower risk of incident HTN and lower 10-year mean rise in BP.
Abstract 11811: Cardiac Biomarkers Differentiate Kawasaki Disease From Multisystem Inflammatory Syndrome in Children Associated With Covid-19
Authors: Geetha Raghuveer, Balasubramanian Sundraram, Nagib Dahdah, Luis Martin Garrido, Elif Seda S Selamet Tierney, Tyler Harris, Michael Khoury, Mark Hicar, Elizabeth A Braunlin, Deepika Thacker, Manaswitha Khare, Frederic Dallaire, Robert W Lowndes, Isabel Glassmeyer, Jean Ballweg, Guillermo Larios Goldenberg, Shae Merves, Cedric Manlhiot, Pedrom Farid, Brian W McCrindle
Journal: Circulation (2022)

Introduction: Kawasaki disease (KD) and Multisystem Inflammatory Syndrome in Children (MIS-C) associated with COVID-19 show considerable clinical overlap making differentiation challenging. Hypothesis: Cardiac biomarkers can differentiate KD from MIS-C. Methods: The International KD Registry enrolled 2566 contemporaneous KD, MIS-C and acute COVID-19 pediatric patients from 39 sites in 8 countries from January 2020 through January 2022. The study population included MIS-C patients meeting CDC criteria with confirmed or probable COVID-19 infection, and KD patients meeting AHA guideline criteria without COVID-19 infection. Included patients had to have at least one measurement of NTproBNP or troponin I. KD and MIS-C patients were compared, to assess factors associated with cardiac biomarkers and cardiac outcomes. Receiver operating characteristic curves were used to determine cut points differentiating KD from MIS-C. Results: Of 779 patients with KD, 168 had NTproBNP (median 381 ng/L) and 173 had troponin I (median &lt;10 ug/L) assessed at presentation, while of 1207 patients with MIS-C, 427 had NTproBNP (median 1850 ng/L; p&lt;0.001 vs KD) and 522 had troponin I (median 12.7 ug/L; p&lt;0.001) assessed. Baseline NTproBNP and troponin were correlated mildly (r=0.09; p=0.05) and were associated with older age and higher creatinine levels. Lower LV ejection fraction (LVEF) was associated with MIS-C (vs KD), but not with baseline or peak troponin levels after adjusting for age and creatinine levels. Lower LVEF was significantly associated with higher baseline and peak NTproBNP levels after adjusting for diagnosis and age. Higher peak coronary artery Z score was associated with KD vs MIS-C, but neither cardiac biomarker. Baseline troponin I &gt;10 ug/L predicted MIS-C vs KD with a sensitivity of 57% and specificity of 74% (c-statistic 0.61), and baseline NTproBNP &gt;1600 ng/L with a sensitivity of 54% and specificity of 75% (c-statistic 0.69). Conclusions: Higher baseline troponin I and NTproBNP levels are more predictive of MIS-C compared to KD. Lower LVEF, more common with MIS-C, was associated with higher NTproBNP but not troponin I levels, and coronary artery involvement, more common in KD, was not associated with either cardiac biomarker.
Abstract 11873: Association Between Perioperative Hyponatremia and Survival After Left Ventricular Assist Device Implantation: A Systematic Review and Meta-Analysis
Authors: Gaspar Del Rio-Pertuz, Juthipong Benjanuwattra, Natnicha leelaviwat, Mahmoud Abdelnabi, Poemlarp Mekraksakit, Erwin E Argueta-Sosa
Journal: Circulation (2022)

Background: Hyponatremia, defined as a serum sodium (Na) level &lt;135 mEq/L, is a common electrolyte disorder in patients with congestive heart failure and cardiac surgical patients, and its presence is associated with increased morbidity and mortality. Few published reports have described if there is an association between perioperative hyponatremia and left ventricular assist device (LVAD) outcomes. The consolidation of these studies could provide information on patient selection for LVAD implantation if hyponatremia is a concern.Hypothesis: The presence of perioperative hyponatremia is associated with mortality after LVAD implantation. Methods: We systematically searched PubMed, Embase, and Scopus for abstracts and full-text papers from inception to May 2022. Studies were included if they evaluated the association between perioperative hyponatremia (Serum Na &lt;135 mEq/L) and survival after LVAD implantation. Data were integrated using the random-effects, generic inverse variance method of DerSimonian and Laird. The study was registered in the Prospero CRD42022334062. Results: After removing duplicated and applying the inclusion criteria, a total of 4 studies published from 2018 to 2022 were included. Two studies including 527 patients evaluated the association between hyponatremia before LVAD implantation and mortality, no significant association was found (Odds Ratio (OR): 1.30 Confidence interval (CI) 95%: 0.74-2.31 p:0.26, Figure 1). On the other hand, two studies including 313 patients, evaluated the presence of hyponatremia after LVAD implantation, and no significant association to mortality was found (OR:1.46, CI 95%: 0.49-4.37 p:0.02, Figure 2). Conclusion: Hyponatremia before or after LVAD implantation is not significantly associated to mortality. These results may suggest that optimization of hyponatremia may not be critical in the perioperative period.
Abstract 11880: Effects of Left Atrial Function on Pulmonary Arterial Pressure in Acute Myocardial Infarction, Hypertrophic and Dilated Cardiomyopathy
Authors: Minjeong Kim, Hyemoon Chung, In-Soo Kim, Chul Hwan Park, Se-Joong Rim, Eui-young Choi
Journal: Circulation (2022)

Introduction: We evaluated differential contribution of the left atrial (LA) function by cardiovascular magnetic resonance (CMR) and left ventricular (LV) fibrosis to pulmonary arterial systolic pressure in hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and reperfused acute myocardial infarction (AMI). Hypothesis: The differential role of the LA function and LV fibrosis indices for pulmonary pressure elevation would be different in various myocardial diseases and there would be a predictive value in addition to the conventional echocardiographic parameters. Methods: Data of 370 patients with HCM (n=133), DCM (n=114) and reperfused AMI (n=123) who underwent both echocardiography and CMR were comprehensively reviewed. Phasic LA volumes, LA-global longitudinal strain (GLS), LA stiffness index, defined as E/e’/LA-GLS and extracellular volume fraction (ECV) of LV were measured using CMR. Results: E/e’ was correlated with PASP in all groups; however, the predicted value was significantly attenuated after adjusting for LA volume and LA strain in HCM and DCM, but remained significant in AMI. The LA stiffness index was related to PASP in HCM (p=0.01) and DCM (p=0.03) independent of LA volume index and E/e', but not in AMI. In DCM, ECV was significantly related to PASP (p&lt;0.001) independent of LA volume index and E/e’. Conclusions: The LA function in HCM and DCM and LV fibrosis in DCM correlated with PASP independent of E/e’ and LA size, contrary to that in AMI. These results suggest the presence of left atrial dysfunction in non-ischemic cardiomyopathies and usefulness of ECV measurement in DCM for the comprehensive evaluation of LV diastolic function.
Abstract 11878: Two Life-Threatening Conditions: Myxedema Coma and Type A Aortic Dissection
Authors: Tanvi Nayak, chris mehta, beth A whippo, Patricia Vassallo
Journal: Circulation (2022)

Case Presentation: A 59-year-old female with a history of hypertension was brought to a local hospital after being found unresponsive at home. Computed tomography angiography (CTA) of the chest showed type A aortic dissection (TAAD) with maximal aortic dimension of 9.0 cm. She was transferred to our center for escalation of care. She had poor neurological status but stable hemodynamic status, without malperfusion or acute cerebrovascular accident. Lab studies showed severely elevated thyroid-stimulating hormone of 80.4 mIU/ML and free thyroxine 4 (T4) less than 0.2 ng/dL, indicating severe hypothyroidism consistent with myxedema coma. Due to her low functional baseline status, surgical repair was deferred. Anti-impulse therapy was initiated with short acting beta blocker and calcium channel blocker infusion to maintain control of heart rate (HR) and blood pressure (BP). Her clinical course was complicated by pulseless electrical arrest and acute renal failure. After 100 mcg of intravenous levothyroxine, she was extubated and regained renal function. After 40 days, she was discharged to an acute rehabilitation center. 6 weeks later, she showed marked improvement in her frailty index, and medications were optimized. She underwent elective aortic repair, coronary bypass surgery, and was discharged to home. Discussion: Due to the patient’s initial neurological status, repair of her TAAD with aneurysmal degeneration was deferred. She was later diagnosed with myxedema coma and her TAAD was deemed chronic rather than acute . Surgical repair of both acute and chronic TAAD remains the gold standard; however, medical therapy with strict control of HR and BP parameters may stabilize the patient for future surgical repair. 1,2 In this case, by treating the patient’s underlying hypothyroidism and managing risk factors, her surgical risk was reduced, and she underwent successful aortic repair, reporting drastically improved functional status and quality of life.
Abstract 10589: Effects Of 3-Hydroxybutyrate on Cardiac and Mitochondrial Function During Heart Transplantation
Authors: Jacob Seefeldt, Katrine Berg, Nichlas R Jespersen, Frederik F Dalsgaard, Pia Katarina Ryhammer, Michael Pedersen, Lars Bo Ilkjaer, Michiel Hu, Michiel E Erasmus, Roni Nielsen, Hans Erik Bøtker, Hans Eiskjaer, Niels Moeslund
Journal: Circulation (2022)

Introduction: Cardiac transplantation following circulatory death (DCD) and normothermic regional perfusion (NRP) is a new strategy that allows assessment of cardiac function and therapeutical interventions before cardiac transplantation. Sodium-3-hydroxybutyric acid (3-OHB) increases cardiac output by 40% in heart failure patients and diminishes ischemia and reperfusion (IR) injury, presumably by improving mitochondrial energy metabolism. Hypothesis: We hypothesize that infusion with 3-OHB during NRP improves cardiac hemodynamic function after NRP and mitochondrial function after cardiac transplantation. Methods: Pigs ~80 kg underwent a 15-minute anoxic cardiac arrest followed by NRP on a heart-lung cardiac bypass machine. During NRP pigs received 3-OHB or Ringer Acetate infusion. We measured hemodynamic function invasively using pressure-volume catheters and mitochondrial function by high resolution respirometry. Results: Infusion with 3-OHB (360mg/kg/h) increased plasma levels of 3-OHB from 0.05±0.06mM to 3.95±1.13mM (P=0.006) following NRP. 3-OHB increased cardiac output by 5.18±0.97 L min -1 (P&lt;0.0001) driven by a 60% reduction in afterload (3-OHB vs. control: 1.4±0.2 vs. 2.2±0.7 mmHg*mL -1 , P=0.02) and an increase in stroke volume of 36±11mL (P=0.006). Following transplantation and 3-OHB infusion, maximally coupled mitochondrial respiration returned to baseline levels corresponding to a 50% improvement compared with control (3-OHB vs. control: 135±25 vs. 78±26 ρmol O 2 *s -1 mg -1 , P=0.0008). The increment was associated with uncoupling of the inner mitochondrial membrane (3-OHB vs. control: 122±19 vs. 70±34 ρmol O 2 *s -1 mg -1 , P=0.018). Transplantation caused a shift in mitochondrial substrate efficiency measured as the respiratory control ratio, favoring 3-OHB over glucose linked substrates (3-OHB vs. glucose: 22±12 vs. 8±4, p=0.0008). Conclusions: Infusion with 3-OHB improved cardiac hemodynamic recovery following NRP. The improvement was driven predominantly by afterload reduction and was associated with an improvement in mitochondrial respiratory capacity.